Speak Out About Your Medical Aid Experience

August 18, 2015

The Competition Commission is conducting an important public inquiry that involves you as a medical scheme member.

The Competition Commission is investigating the way competition plays out in the medical insurance sector. It also wants to know how the dream of quality private healthcare for all South Africans can become a reality.

It is a timely move that seeks to balance the scales between the private and public healthcare sectors. For a long time the state of the public sector has enjoyed all the attention. However, the weaknesses of the private sector are now in the spotlight.

In the quest for profits, it appears that medical world has overlooked the constitutional rights of patients. The medical world has taken advantage of many patients and medical scheme members.

The ignorance is far from willful. Often they are under the care of medical service providers and in no position to demand that vital information from the medical scheme or healthcare provider. All they want is to cater to have their health catered to. Medical personnel withhold information from them because of their vulnerable position. And that robs them of their power to make decisions beneficial to them. It’s not like when you’re out shopping for clothes where you can go around shopping for the best value.

Competition Commission Gets Complaints About PMBs

This explains why the Council for Medical Schemes receives many complaints concerning the Prescribed Minimum Benefits or PMBs. A case in point is where a medical scheme pays for a prosthetic limb. This is on the PMB list. But then it declines to pay for the procedure required to insert it. Section 27 of the constitution states that all schemes must pay for PMBs in full. However, such schemes try to find loopholes in the wording so as to minimise claims payouts. No wonder there is dissatisfaction among most of the eight million South Africans who rely on the private healthcare sector.

And this is why an NGO going by the name Section 27 was formed; to hold these providers to account. This organization insists that in choosing to operate in the health sector, the healthcare providers accepted the constitutional obligations to provide access to healthcare.

Up to this point in the inquiry, Section 27 has received a number of submissions, but few of them are from patients. Surprised that the principal party affected is not represented in the inquiry, the lawyers representing Section 27 wondered where the voice of the patient was. For this reason a number of public hearings have been called for, so that members of the private medical schemes can come forward and give their story.

These Competition Commission hearings were to begin mid-2015 but have now been pushed forward to the beginning of 2016. This gives you time to prepare your testimony. But if you have it ready you don’t need to wait, you can write it on Section 27’s Facebook page or send an email to the commission at ccsa@compcom.co.za.